Co-pays and No-pays

The price of prescription drugs has long been a contentious topic in the United States. Popular outrage and demands for more affordable drugs have led, in recent years, to Medicare Part D, state-based drug importation programs, and a variety of assistance programs from pharmaceutical companies. Exactly what counts as “affordable” varies, of course, from person to person. But as a recent study shows, price can has a significant effect on whether someone chooses to take a drug, even if it has already been prescribed.


The study, published in the Annals of Internal Medicine, tracked prescriptions ordered through CVS Caremark, the pharmacy chain and pharmacy benefits manager, from July through September 2008. During this period, 10.3 million prescriptions were filled for 5.3 million people with an average age of 47; 60% were women. The average family income in neighborhoods serviced by these pharmacies was $61,762.

According to a HealthDay article on the study, 3.27% of prescriptions were abandoned over the course of the study. Cost was the biggest factor in whether a prescription was picked up; a co-pay over $50 made a drug 4.5 times more likely to be abandoned at the counter. In contrast, drugs with a co-pay less than $10 were abandoned only 1.4% of the time. Cold, cough, allergy, asthma, and skin medications were most likely to be abandoned. Insulin was abandoned 2.2% of the time. Electronically delivered prescriptions were 64% more likely to be abandoned than hand-delivered ones.

Have you ever intentionally abandoned a prescription? If so, was cost a major factor in your decision? What other factors did you consider? Have you ever discussed less expensive drug alternatives with your doctor? Did this end up saving you money? Leave a comment below!

Learn more about the health and medical experts who who provide you with the cutting-edge resources, tools, news, and more on Diabetes Self-Management.
About Our Experts >>

  • Jerry

    I have Type II and had been taking Avandamet for several years, and recently switched to Actoplus Met. With my HSA deductible being so high, I paid cash for Actoplus Met, once, $305/month! So, I switched to Glyburide and Metformin for about $18/month. It’s cheap and seems to work better for me.

  • Diane G

    The only prescription I ever abandoned was one for my test strips for my blood glucose meter. The Medicare Part D I have pays very little and I sometimes just can’t afford it because I am on Social Security Disability. I feel this is the most important prescription but when it becomes 10% of my monthly income, I just can’t do it.

  • mary little

    what really hurtsd is the drug companies offering all these discounts and stuff but if you are on a limited income like medicare and mediaid they don’t cover those things in the fine print that is especially true of the freedom lite and their wonderful discount card that won’t work and i am still left with enormous strip costs and i notice this for whole classes of drugs used a lot by the elderly on fixed incomes like myself and this programs worked well until medicare d came along

  • steve davis

    I’ve abandoned prescriptions because I didn’t need the scrip by the time I got to the pharmacy. Or one time my ex got a prescription for cortisone for our boy, but I found double rinsing his laundry and his rash cleared up on its own – before either of us picked it up. Or the doctor sent in one that’s not in the formulary of my health plan. Only the last is “slightly” economic. I think the assumption that backing out of a sale is considered a “bad” thing is a clue as to why the health care system is such a mess.

  • Bert

    I have Type II and had been taking ActoPlusMet. With my HSA deductible being so high, I paid cash for ActoPlusMed Met. The doctor switched me to Glipizide and Metformin which didn’t work as well.
    I added 40 units of Lantus at night and now under control. I was prescribed Flex Pen at first and it also wasn’t covered, so I switched to the vial.

  • Kathy

    I have noticed that if one has medicare or state aid or other insurance one cannot get help from the drug companies paying for prescriptions. It is assumed by the drug companies that one’s insurance will cover the drugs when they may not.
    You almost have to be living on the street and be homeless to be covered by the pharmaceutical company to have the medication covered. Something is just plain wrong with this picture.
    Also I noticed that many of the drugs that are on the $4 or $5 plan you have to have insurance to get those drugs on those plans. If you don’t have insurance you are stuck paying full price for them.

  • Natalie Sera

    I haven’t abandoned any medications, although I’ve cut down on some that I didn’t need such a high dosage with the blessings of my doctor.
    What I’m really scared of is when I get to Medicare age, I will lose the excellent coverage I have with my current retirement insurance. I take a LOT of medications because I have multiple medical conditions, and if I had to pay for even 50% of them under the new “donut hole” coverage, I couldn’t afford it. I hate the thought of giving up my pump and my CGM — they have made such a difference in my life! But I don’t know if I have a C-peptide low enough for Medicare to cover my pump, and I know they don’t cover CGMs.
    I am 19 years into diabetes with no complications, and I want it to stay that way!

  • RoseMarie Brown

    I have 2 medications that my co-pay is $116(going up to $126 in 2011). Being on social security, this hurts badly. Januvia is one of them(other is blood pressure med). I cut the pills in half and take half doses. Now my script last 6 months instead of and it is working just as well. Dr is very adament about me taking it. Am also on glyburide which is very affordable and no problem. Am type 2 diabetic.

  • Susan

    Ironic this topic shows up now. I am about to meet with insurance people to see what can be done about high cost of my secondary with Medicare being primary. Right now covered by husband’s group insurance but premiums are going up and up and up. Cost of medicine and supplies rising too. And I don’t waste supplies and meds but what I am using may end up getting changed if insurance changes. What do you do if your program is working but is not covered by insurance??? What do you do then????

  • Doreen

    Yes, I have left perscriptions at the counter due to the high cost of the co-pay. I have also asked my Dr. to help me find less costly alternatives.

    I used to work and between my husband and I, we made a very good living. We had a reasonable amount of disposable income and I carried our insurance. It was a better plan than my husbands.

    When my health became bad enough I had to step away from my career, we found that the change in insurance plans not only effected the medication co-pay costs but also the cost of specialist care. Our breaking point is about $20.00. If anything costs more than that, we have to do without something….The medical care is the first to go except for my followups to keep my medication managed…

    This being said, I am not getting any better….I am simply existing…

  • Linda Myers

    I recently totaled all of my co-pays for medications and I pay $520 a month. I’m just unfortunate enough to have had cancer twice, be on an insulin pump and have congestive heart failure. I don’t know what I will do when I am unable to work and be able to afford all of the medication I will have to take. I guess I’ll die.

  • Cheryl Pahys

    I am a Type I diabetic and have been for 36 1/2 years now. There is no way I can give up my drug since I am on insulin. I am waiting for disability so therefore, am on a discounted insurance, which isn’t medical insurance. The price is astronomical, but I need it to survive. I am also on bipolar medications and have switched to generic meds, but they are still expensive. Something drastic has to be done about meds.

  • Tia

    Listen up! I’m pretty poor and have no money to speak of so I took the walmart 4 dollar meds list to my doctor and told her if it’s not on there DONT GIVE IT TO ME!!! That’s saved me a boat load of money!

    The second thing I did was stop buying into the “you must eat carbs lie!” It is a lie and you don’t have to eat them. I stopped and have lost 52 pounds (in 79 days!!) and my doctor just took me off ALL MEDS!

    Do you hear me??? I NO LONGER TAKE MEDS as of 4 days ago!!! Carbs are the enemy if you’re a type 2. Yes it’s hard but pricking my finger 3 times a day and taking a ton of meds is worse! DO NOT EAT CARBS! EAT PROTIEN and get your carbs from green veggies. Yes, green veggies have carbs. YOU WILL LOSE WEIGHT AND PROBABLY WILL NO LONGER NEED MEDS!

    I resisted for months! Do you want to eat bread or do you want to get off your meds! THINK ABOUT IT!!

    Merry Christmas and bless all of you!

  • Erika Hannemann

    I have type II diabetes and also high blood pressure and gout, along with high cholesterol and high triglycerides.
    Recently, my mail order pharmacy informed me that the manufacturer for colchicine, one of the two gout meds I am on, has stopped making the generic form and I now will have to take Cholcris, which is the brand name for colchicine.
    When I went to pick it up at the pharmacy, the copay for one month was over 50.00.
    If anyone knows of a less expensive generic med for colchicine I would love to hear about it from you.
    I am in my 70’s and live on Social Security and a pension I earned working as an R.N. for the State.
    You can imagine that I don’t have a lot of discressionary money to spare.
    I left the medication at the pharmacy.
    My physician insists that I need to take Lovaza for the high triglycerides. The copay for a three month supply of that med is 285.00 because it is a tier 3 medication. I have been taking half of the prescribed dose of that drug because of the cost.

  • Karl

    I am 52 and have been on disability since 2002. I have Type 2 diabetes. I have never abandon a prescription for my insulin. I take it regularly at the beginning of the year but it doesn’t take long before I hit the “donut-hole” of Medicare D. That is when I just quit taking my insulin’s. My BG is far from under control; but, I can’t afford around $1,200.00 a month for each of my 2 insulin. I don’t qualify for any programs either. With all the “sample medications” that representatives hand out, you would think that the drug companies could cut that back and reduce the cost of their drugs!

  • al

    Its the donut hole $5000 per year plus… wont cut it on year more out of pocket , withe the promis of a 50% discount increasing the time for out of pocket and reducing the criticle coverage. crunch the numbers Total retale will exceed $13000 this year. next year the out of pocket will be larger my ira will be smaler. Disability retirement sucks.

  • Lynne R.

    This note is to Diane G and anyone else who gets diabetic supplies. If you are on Medicare or a Medicare Advantage plan your diabetic supplies, other than insulin, are to be FREE by law. If you have access to a computer at the library, etc., look up diabetic supplies. You will get a long list of suppliers to choose from. They do not handle drugs, only the test strips, machines, solution, lancets, etc. They will mail them to your home each quarter according to how many times a day you are to do testing. They need a prescription from your doctor and a form from you. That is all you do to get free supplies.

    Also, I am on a Medicare Advantage plan that is free, includes a drug plan, and charges me $5 a month or $15 for 3 months for my meds. The list of covered meds is very long. I tell my MD that everything I take has to be on that list, which includes Metformin, several cholesterol drugs, lopressor, digoxin, lasix, etc., many of the common medications for anything.

    Do a little research and you can save money. I used to have to pay $500 a month. Now I pay about $800 a year and I take 7 medications.

    Lynne R.

  • Kathy McG

    I have abandoned prescriptions on a few occasions because I could not afford the copay ($305 for a 3 mos supply of one of several medications that I take) I have Type 2 Diabetes & was recently told of some kidney issues so my Metformin & Glipizide were D/C’d. Now I am on Levemir, Novolog & Victoza and unless my doctor continues to give me samples, I will not be able to continue to take them! Because I have Medicare Part D coverage (I am on SS Disability),I can’t get pharmecutical company assistance. Some of my copays are so high, I must choose whether to take the medicine or pay a bill. Most times the bill takes precedence, which is not good for my multiple medical conditions. If my income was just slightly lower, I’d be eligible for a Medicaid Buy in Program for people who work. So when my medical condition deteriorates & I can’t work anymore maybe THEN I will be able to finally take all the medications I need. If not….

  • Cathy

    I have type II diabetes, high blood pressure, high cholesterol, depression, and my opthamologist just informed me I have the beginnings of glaucoma. I am 61 which means that I could retire from my job at the end of 2011. I will not be doing that exactly because of my drugs and doctor expenses. I am on the flexpen and metformin plus 2 blood pressure meds, a statin for cholesterol and beta blocker eye drops for my glaucoma. My opthamologist is giving me samples right now because I just started and he wants to be sure they are the correct thing for me. I will have to work until I can get on Medicare even though I have a really great retirement pension and 401K. Every time I do the math I am frightened that I may have to work until I die just to afford drugs. However, I got a few good ideas from some of the comments so I don’t feel quite so scared about the future. Thanks for the tips and a forum to voice my concerns. I really appreciate it.

  • Madavor Media

    Dear Mr. Sotomayor:

    I’m sorry to hear that you are going through such a difficult time. There are a number of programs that may help. First off, many of the pharmaceutical manufacturers have programs to help people who qualify receive medicines at no or reduced cost, including the following:

    Lilly TruAssist:

    Takeda Patient Assistance Program:

    Sanofi Patient Connection:

    Novo Nordisk Patient Assistance:

    (Lilly, Sanofi, and Novo Nordisk are all insulin manufacturers.) Googling the name of a manufacturer along with “patient assistance program” can help you find more of these programs.

    Retailers such as Meijer, Publix, Kroger, and Wal-Mart also sometimes offer certain diabetes medicines for free or at reduced prices. You can learn more about that at the following locations:

    The savings cards referenced in the second article may also be of use.

    There is also a website that can help you compare the cost of medicines from one retailer to the next in your area. That can be found here:

    You might also be interested in our article “Getting a Hand From Social Agencies”:

    I hope that these resources are helpful and wish you the very best of luck.

    Diane Fennell
    Web Editor